Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
90 Cards in this Set
- Front
- Back
|
What shape are RBCs?
|
Biconcave
|
|
|
A normal neonate is born with enough stored iron to produce hgb for how long after birth?
|
4-6 months
|
|
|
What is the life span on healthy RBCs?
|
120 days
|
|
|
What type of Hgb predominates neonates?
|
Hgb F
|
|
|
At what age does erythropoiesis increase?
|
2 months
|
|
|
Wat is the difference between HgbF and HgbA?
|
HgbF has a higher affiinity for O2 than adult Hgb
|
|
|
When do quantities of Hgb F rapidly decrease to trace amounts?
|
6-12 months of age and are replaced by HgbA
|
|
|
What is Anemia?
|
The number of RBC and/or HgB concentration below normal, resulting in decrease carrying capacity of blood to tissues
|
|
|
What is the most common hematologic disorder in infancy?
|
Anemia
|
|
|
What is the cause of anemia?
|
By the loss or destruction of existing RBC, or impaired or decreased rate of RBC production
|
|
|
Is anemia a disease?
|
No, it is a manifestation of something else. Ie diet; blood loss
|
|
|
What is a technique used to differentiate the cause of anemia?
|
Can look at the reticulocyte counts
|
|
|
What type of hemotologic impairement is common with decreased reticulocyte counts?
|
An anemic disorder caused by impairment in production of RBCs
|
|
|
If a pt with anemia is found to have an increase in reticulocytes, what is the cause of the anemia?
|
Hemolysis of RBC or blood loss
|
|
|
What are 2 examples of causes of RBC hemolysis leading to anemia?
|
Sickle cell disease and chemotherapy treatments
|
|
|
What virus has bee known to impair RBC production?>
|
Parvovirus
|
|
|
What is a possible cause of microcytic RBC?
|
Small size can be due to lead poisoning
|
|
|
What are the 3 ways to classify anemia?
|
Through what causes it:
1. excessive blood loss 2. destruction of RBCs 3. impaired or decreased production of RBC |
|
|
What arethe 4 consequences of Anemia?
|
1. Decrease O2 carrying capacity of blood
2. Decrease in amount of O2 to cells 3. Decrease in blood viscosity --> tachycardia 4. chronic severe anemia --> growth and sexual delay |
|
|
List the clinical manifestations of anemia.
|
Muscle weakness
Fatigues easily SOB Pica Pale Headache Dizzy Irritable ↓attention span Depression Signs of shock Muscle weakness Fatigues easily SOB Pica Pale Headache Dizzy Irritable ↓attention span Depression Signs of shock Muscle weakness Fatigues easily SOB Pica Pale Headache Dizzy Irritable ↓attention span Depression Signs of shock |
|
|
What is the management option for anemia?
|
Treat the underlying cause
|
|
|
What are the nursing tasks for anemia?
|
1. Anemia
2. history 3. Test stool for blood 4. education |
|
|
What is the most common form of anemia in infancy?
|
Iron deficiency anemia
|
|
|
What are the causes of iron deficiency anemia?
|
1. Decreased supply of iron
2. Impaired iron absorption 3. Increase in body's need for iron 4. Synthesis of Hgbaffected |
|
|
What two vitamins can cause Hgb deficiency if not consumed adequately?
|
Vitamin B12 and folic acid
|
|
|
Which groups of people have a higher need for iron?
|
Premature infants; adolescent females and pregnant women
|
|
|
What disease is associated with impaired iron absorption leading to IDA?
|
Crohn's or celiac disease
|
|
|
What does MCV stand for and what will it appear as on a CBC in an anemic pt?
|
MCV: mean copuscular volume; which is the size of a single RBC.
In an anemic pt it will be decreased |
|
|
What is MCHC? Is it increased or decreased in anemic pts?
|
Mean corpuscular hemoglobin concentration: the avg concentration of Hgb in a single RBC
it is decreased in anemic pts |
|
|
How do RBCs appear in anemic pts?
|
Microlytic and hypochromic
|
|
|
Why do anemic pts have increased serum binding iron capacity?
|
with anemia you have decreased circulating RBCs and thus less iron will be bound to the binding sites on transferin. You do not reach saturation.
|
|
|
Why does the reticulocyte count often go up with IDA?
|
Because the body tries to put out more new RBC to compensate for the decrease in iron ciruclating
|
|
|
What foods are fortified with iron?
|
Red meat; dark green leafy veggies; cereals with iron; nuts and beans
|
|
|
What is the protocol for administering liquid iron suppliments?
|
Squirt them in the BACK of the mouth and be sure to used proper mouth and teeth care. Best given between meals for absorption, but can be given with food.
|
|
|
What color changes in stool should you warn parents of children taking iron suppliments?
|
Green; not black!
|
|
|
What is a diagnostic technique for IDA?
|
Administer iron suppliments and follow up with a blood panel. If the have increase in Hgb levels of > 1.0g/dl then is it iDA and requres 2-3 additional motns of therapy to replenish iron stores
|
|
|
What must be administered with Ferrous sulfate to help with absorption?
|
Vitamin C
|
|
|
What is sickle cell anemia?
|
Hemoglobinopathy when normal adult hgb (HgbA) is partially or completely replaced by abnormal sickle Hgb (Hgb S)
|
|
|
What type of genetic trait is sickle cell?
|
autosomal recessive
|
|
|
When do symptoms of sickle cell often manifest and why?
|
After infancy due to left over HgbF for the first 6 months of life
|
|
|
What is the most common genetic disease in the US?
|
Sickle cell
|
|
|
What causes sickle cell?
|
Specific substitution of the amino acid valine for glutamic acid in the 2 beta chains of hgb
|
|
|
What occurs to sickled cells that become deoxygenated?
|
Crystalization that changes biconcave cells to sickled
|
|
|
Can sickled cells restore to biconcave? IF so how?
|
Yes, through proper oxygenation; but after a period of time the cell eventually dies and cannot be restored to proper shape
|
|
|
What does sickled cells cause in the vasculature over time?
|
Damage and scarring to the lining of the vasculature
|
|
|
What is the average lifespan of RBCs in sickle cell?
|
28 days
|
|
|
What are the triggers leading to a sickle crisis?
|
1. Fever
2. Emotional or physcial stress 3. increase blood viscosity (low fluid intake or fever) 4. hypoxia or low O2 tension 5. conditions that increase the body's need for O2 or alters transport of O2 |
|
|
What is often the first symptoms seen in sickle cell?
|
Dactylitis: swelling of the hands and feet
|
|
|
What are parents taught to do with children with sickle cell disease?
|
Palpate the spleen to chec for splenic sequestration crisis
|
|
|
List the acute symptoms of a sickle cell crisis.
|
Vaso-occlusive
Sequestration on Aplastic Hyperhemolytic Megaloblastic anemia Chest syndrome CVA |
|
|
How is vaso-occlusive symptoms treated in the sickle cell crisis?
|
With fluids and pain management
|
|
|
What is the most severe side effect of sequestration?
|
Shock
|
|
|
What is a common trigger of aplastic symptoms of sickle cell crisis?
|
5th disease: parvovirus: which is a profound anemia
|
|
|
What symptoms is secondary to hyperhemolysis in a sickle cell crisis?
|
Jaundice
|
|
|
What can cause megaloblastic anemia?
|
When the pt is not taking folic acid and the body has an excessive need for it
|
|
|
What are the most dangerous of the acute symptoms of a sickle cell crisis?
|
Chest syndrome and CVA
|
|
|
What is chest syndrome>
|
Similar to a pulmonary embolus; causes chest pain, fever, severe anemia and pneumonia like cough
|
|
|
What population of sickle cell pts are most commonly associated with CVAs?
|
adolescents
|
|
|
What are the symptoms of Sickle Cell Disease?
|
Delayed growth & puberty
Chronic hemolytic anemia Pallor, jaundice sclera Fatigue Cholestasis Avascular necrosis of hips & shoulders Renal dysfunction Retinopathy |
|
|
What is the best preventative therapeutic management for sickle cell crisis?
|
Hydration to cause hemodilution
|
|
|
What are the activity requirements for a child during a sickle cell crisis?
|
Bed rest
|
|
|
Why is O2 therapy not necessarily required for treatment of a sickle cell crisis?
|
Because O2 will interfere with the production of RBCs and you want to prevent that from happening.
|
|
|
At what age is a PCA able to be given to a child?
|
age 6
|
|
|
If a child with sickle cell is on morphine and during your assessment you see a change in mental status, what may be the cause?
|
They may have Severe Anemia!! Don't assume that it is the morphine
|
|
|
What Hgb level is wanted for children with sickle cell and why?
|
Want to keep them below 10 because if it gets too high then the blood will become too thick
|
|
|
What is the only indication for regular transfusions for sickle cell patients?
|
If they have had a stroke
|
|
|
What are the medications given for sickle cell disease?
|
Folic Acid
Antibiotics Vaccines Pain medications Hydroxyurea |
|
|
The greatest risk of death for children with sickle cell under 5 years old is _____.
|
Infection
|
|
|
What is Beta Thalessemia (Cooley Anemia)?
|
Applied to inherited blood disorders characterized by deficiencies in rate of production of specific globin chains in Hgb
|
|
|
What type of genetic trait is beta thalassemia?
|
autosomal recessive
|
|
|
What are the pathophysiologies of Beta Thalassemia?
|
*Defective synthesis of Hgb – abnormality of beta peptide chain in Hgb synthesis
*Structurally impaired RBC – impairs RBC ability to carry 02 *Shortened life span of RBC *To compensate for hemolytic process, an overabundance of erythrocytes formed |
|
|
What are the clinical manifestations of Beta thalassemia?
|
*pallor
*growth & maturation retardation *anemia *enlarged head *frontal & parietal bossing *severe maxillary hyperplasia *malocclusion *bronze skin tone |
|
|
Signs and symptoms of Beta Thalassemia that appear in the first 2 years of life
|
* life-threatening anemia
* pale and listless * poor appetite * poor growth * jaundice * spleenomegaly * hepatomegaly * cardiomegaly * boney deformities |
|
|
List the methods of diagnosing Beta Thalassemia.
|
*Changes in character of RBC
*↓ in Hgb & Hct *Hgb electrophoresis confirms diagnosis *X-ray of bones to detect characteristic changes |
|
|
Which disorder requires blood transfusions every 3 weeks as management?
|
Beta Thalassemia
|
|
|
What is included in the blood transfusions used to treat beta thalassemia?
|
Desferal- iron chelation agent
|
|
|
List the follow up procedures for Beta Thalassemia.
|
*Cardiac assessment
*Audiology screen *Endocrine evaluation *Oral glucose tolerance test *Hepatitis panel *Quantitative iron staging (ferritin) *Nutritional, growth, opthalmologic and dental evaluations *Psychologist and social worker |
|
|
What is the name of the drug used in sickle cell treatment that helps to increase the production of HgbF?
|
Hydroxyurea
|
|
|
What is the perscribed dose for folic acid?
|
1mg twice a day
|
|
|
What antibiotic and dosage is used to treat sickle cell in children under 3?
|
Penecillin: 125mg 2x per day
|
|
|
What is the antibiotic protocol for children over 3 with sickle cell?
|
Penecillin: 250mg bid up until all of their immunizations are done
|
|
|
why is penecillin required for children with sickle cell until all their immunizations are complete?
|
Because their spleen is not functioning yet
|
|
|
What immunizations are required for children with sickle cell?
|
All the same that any other child will receive with an extra vaccine for pneumoccocol: at age 2 and it covers 23 strains of the virus. They also get the meningitis vaccine early (at age 2)
|
|
|
How many strains of pneumococcol virus does prevnar cover?
|
13 strains
|
|
|
Which pain medication should never be used with sicklers?
|
Demerol: it can cause seizures
|
|
|
What are the common pain medications that can be used at home to prevent a child with sickle cell from coming to the hospital?
|
Start with NSAIDs at home; then oxycodone; tylenol #3; then they must come to the hospital
|
|
|
Other than medication, what has been found to help with the painful outbreaks of a sickle cell crisis?
|
Guided imagery
|
|
|
What is the requirement for sickle cell patients to do if they have a temperature over 101.5?
|
They must notify their HCP
|
|
|
What should never be used to help with knee/bone pain for sickle cell patients
|
Never use ice. Use warm towel
|
|
|
Why is it important to keep in contact with the school nurse of a child with sickle cell?
|
He or She can tell the HCP if the child is having problems in school which could be a sign of small TIAs that can lead to stroke
|
